My position is very clear, Academic selection and streaming are essential if we are to allow the brightest children in our schools to flourish. They are the future leaders of our country, our innovators, our scientists, our financiers, our doctors, our business champions, our civil servants. We NEED them to achieve their potential if we are to do so as a country. I do not think selective entry to school is necessary if schools have sufficient numbers of pupils and resources to provide a truly intellectually stimulating environment for the brightest children. If we are unable to provide that environment then we need selective schools.

The corollary to that is that most of our children are not the brightest, and they need to be given the opportunity to thrive as well. This is where the Grammar school system let us down, or rather the secondary moderns did. Secondary schools should all be able to educate children to a university standard (whatever that is these days). If there is a selective school in the area then it needs to work in partnership with the local non-selected school to identify late developers and include them.

I do not believe that binary selection at 11 is an appropriate way to sift our children, and late developers have to be given the same educational opportunities as precocious children (see above).

But my major problem with education in this country is that too many state schools are simply too unambitious for their children. No matter how well they are educated, they are not given the ambition to succeed, the belief that they can be captains of industry or prime minister. The best they can hope for is to be a ‘B’-list celebrity. That is what is missing. That is what I hope City Technology Colleges and other secondary schools in the future will provide. But we have to prioritise the brightest children

I went to a football match on Sunday. I took my 7 year old son. I haven’t been to a live footie match for several years-in fact since I became a father. There was a moving moment of solidarity with the McCann family. After that, the singing started. Here’s a sample of what the Chelsea fans were singing to their Everton visitors. (Those of a tender disposition do not read on)

In your Liverpool slums
In your Liverpool slums
You look in the dustbin for something to eat
You find a dead rat and you think it’s a treat
In your Liverpool slums

In your Liverpool slums
In your Liverpool slums
You s**t on the carpet, you p**s in the bath
You finger your grandma, and think it’s a laugh
In your Liverpool slums…

It goes on and it doesn’t get any better. Now I know that I wasn’t in the family enclosure, although I was surrounded by children. I know that football is an emotive part of may peoples lives. I think I have a sense of humour which is not especially delicate, and I have a more or less complete mastery of Anglo-Saxon vernacular, which I use regularly. But I don’t want my children or anyone else’s growing up learning to hurl ritual abuse at people. I don’t like them thinking it’s normal to be so tribal. I want them to be able to think as individuals, not as part of a baying mob. I also don’t see how it is very different from racist abuse. Not of course that I particularly like Liverpool myself!

Maybe that’s my prudish middle class background. I certainly don’t remember having the same objections 20 years ago. But I’m not sure I will take my son back to Stamford Bridge, at least not for another 5-10 years

Dr Crippen has THIS post today about the lack of availability of Tarceva (erlotinib), a drug about which he has strong views and has previously posted. I think it may be helpful to consider the case of this drug in a little more detail. Tarceva is a drug which is licensed for the treatment of lung cancer after previous chemotherapy. It is no available on the NHS as it is deemed by NICE not to be cost-effective (though interestingly it is cost-effective in scotland-work that one out if you can!)

There are 2 other drugs licensed in this situation, namely docetaxel and pemetrexed. Only docetaxel is available in the NHS. The following are 3 graphs showing the survival figures for 1) tarceva vs placebo, 2) docetaxel vs supportive care and 3) docetaxel vs pemetrexed

1)

2)

3)

They show (to me, anyway) that both docetaxel and tarceva give a survival advantage over supportive care alone, amounting to an approximately 10% absolute survival advantage at 1 year. The third graph shows that pemetrexed is as effective as docetaxel.

The costs of these drugs (approximately) are as follows:

Tarceva £1,800 per month (average course will be around 3 months, may go up to 18 months)

Docetaxel £6600 per course

Pemetrexed £8000 per course

These drugs have different side effects, different risks, one may be more suitable for one patient than another. I believe they all have a role, and in the private sector I am able to discuss with patients the pros and cons of each and come to a decision as to which is better for an individual patient. Why am I not allowed to do the same in the NHS, where the choice is docetaxel or nothing? Just because it is the cheapest does not make it the best choice. Indeed for a patient who is likely to have side effects from docetaxel, tarceva may be more cost-effective. The only people who will be on the treatment fo more than 6 months will be those who are benefiting, and in those patients the drug is cost-effective. The people in the best position to make these decisions are the oncologist and the patient, NOT the DoH. If they had their way, oncology could be practised by automatons.

Now, that said there has to be rationing in the NHS. There will be drugs and treatments that we cannot afford. I feel, however that if these treatments are available in every other developed country but not the UK, then we have set the cost limit too low, and this is reflected in the fact that our cancer outcomes are amongst the worst in the developed world. It might be that we decide that this is acceptable and we will not devote resources to treating cancer as it is not cost-effective. If so, I will look for a new job.

Britain is one of the worst places in the developed world to be if you get cancer, researchers from Sweden’s Kaolinska Institute have shown HERE . But bizarrely one of the leading nations in the world in research against cancer. I am afraid that this will come as no surprise to those of us who treat Cancer for a living.

However I was interested to hear Karol Sikora, a well known UK oncologist on radio 4 this morning. He says he wants rationing by NICE to be explicit and timely so that the NHS can provide a “core service”, with the implication that people would have to pay for anything over and above the core service. This is not, of course, what Patsy and the DoH want us to believe. You can hear the interview HERE

But speaking as I was previously of perverse incentives and conflict of interest, I wondered whether Dr Sikora might have mentioned that he is the leading light behind CancerpartnersUK, a private venture providing oncology services to NHS and private patients, and centres where people will be offered a basic “NHS” package with the opportunity to pay extra (to Dr Sikora’s dispensary) for additional drugs like erlotinib or bevacizumab which are not available on the NHS. So, to look at it cynically, he has an incentive for the basic NHS package to be as basic as possible to encourage his own business.

Now I think this is a model which may well work and may have benefits, but I think Dr Sikora would be well advised to declare his interest in this organisation, which is more significant than his NHS commitment, which I understand to be minimal.